Methotrexate

Good Afternoon..been on MXT for two years..5mg weekly to 25mg currently..MXT not working..Prednisolone only thing that has any affect..any other treatments/meds i should ask Rheumatologist about on next consultation?

Thanks

[KittyJ]

Your rheumy will probably have a plan for your next meds but this publication might help you to know what the options are,

nras.org.uk/information-sup...

[Hidden in reply to KittyJ]

Thank you..i should have mentioned my condition is psoriatic arthritis..good info on the link👍🏼

[Garnacha in reply to Hidden]

Hi Harry, I was diagnosed with PsA in November, I first saw the consultant in January last year, initially he thought it was tendinitis and gave me 2 steroid injections in my elbow, shoulder & hamstring & prescribed me with etoricoxib, when I saw him again in March (just before lockdown) I said that the elbow & shoulder injections had helped a bit but not the hamstring, he then put me on hydroxichloroquine, in April with my elbow still the same as when he gave me the injection but not improving I stopped the etoricoxib, within a few days the pain in my elbow came back pretty bad so I resumed taking it again which helped, throughout the summer the pain in all areas came back worse than ever so arranged an appointment with him in November, this is when he said it was PsA, he gave me another steroid injection in my shoulder & innerside of my elbow & put me on 15mg methotrexate and said to increase it to 20mg after 8 weeks but to stop the hydroxy, again within a couple of days I was in absolute agony in places I'd never had pain before plus the original sites i.e. elbow, shoulder, the consultant said to resume the hydroxy. By December 10th I was in so much pain and couldn't cut up my food, the GP prescribed me prednisolone for a week which took a slight edge off the pain but then I developed a burning sensation in my arm, managed to speak to the consultant a week later who said it sounded like nerve pain and prescribed me with gabapentin, 100mg 3 times a day for a week increasing to 200mg 3 times a day & then 300mg 3 x a day. I saw the consultant on the 19th January and said that the burning pain was still there but not quite as bad and also the pain in my elbow & more particularly my hamstring which hasn't improved at all and got worse since January last year, he gave me another steroid injection in my outer elbow & said to give the MTX another 4 weeks and to increase the gabapentin to 2 x 300mg in the morning and if needed after 2 weeks to increase another dose the same, as of yesterday I'm now taking 1500mg a day, this is just for the nerve pain which he said is probably caused by inflammation pressing on a nerve.

Not sure if any of the above helps you, but, the etoricoxib & hydroxy must be helping in some way, last weekend I actually woke up and my elbow for half an hour wasn't hurting

😀 but by the time I'd had a shower etc it was back, hoping this is the start of being pain free although my hamstring is still the same

briefly I'm taking 90mg etoricoxib, 200mg hydroxy, 20mg MTX & 1500mg gabapentin a day

[Hidden in reply to Garnacha]

Thanks Garnacha..i have telephone appointment with Rheumatologist on March 1st..its really my left shoulder and breastbone/sternum that are giving me most pain..shoulder is almost frozen.

[Garnacha in reply to Hidden]

aaw maybe he'll be able to suggest a steroid injection to help your shoulder, not sure about the breastbone / sternum and hopefully be able to prescribe something that'll help, good luck. Deb x

[oldtimer]

It really is worth looking at the NRAS site at the treatments as suggested. Then you can have some knowledge about the drugs that the rheumatologist might use. The JAK inhibitors seem to be a popular choice for Psoriatic Arthritis currently, but they might want to add in other DMARDs like hydroxychloroquine and /or sulphasalazine first.

[Hidden]

If mtx isn’t working on its own, the next step is usually to add in a second medication. Which one is down to your rheum (and you) to decide, but of the traditional DMARDs, Leflunomide has a good reputation for being useful for PsA. I started on mtx for likely PsA last January with no benefit, increased the dose after 10 weeks, still couldn’t get off steroids, so after 16 weeks added in lef. Within 4 weeks of starting the lef I was able to get off the pred without ending up back at square one. Since then, I had a further mtx increase in July and have been on 25mg injections since August, but found no further improvement. They then increased my lef in mid December, and that has had an impact, but my arthritis still isn’t under control. Unfortunately, because I don’t have 3 visibly swollen joints at any one time (even though I may have pain in 3 or more), I don’t meet the criteria for considering biologics, so the only thing they’re willing to do is to consider adding in sulfasalazine if I’m still not under control when they next review me. At this point, I’m pretty sure that the only drug actually doing anything meaningful for me is the leflunomide, so in my case, adding in a third might not be a bad thing.